Join us as we explore how Gawande’s revelations challenge conventional medical practices and encourage conversations around end-of-life care. Al shares his personal experiences and professional insights, reinforcing the significance of checklists in navigating life’s complexities. Whether you’re approaching retirement or planning for a loved one, this episode is a treasure trove of knowledge and practical advice.
Welcome to Retirement Unpacked with Al Smith, owner of Golden Eagle Financial. You want a retirement plan that alleviates your fears about the future so you know your money will last. As a chartered financial consultant, Al Smith will help you find a balance between the risk and reward of the market and the safety of your retirement income. And now, here’s your host, Al Smith.
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Welcome to another program of Retirement Unpacked. I want to thank you for tuning in. I’m sure there’s other things you could be doing, but you’re listening to me. I appreciate that. If you would like to have a conversation with me about some of the topics I talk to people about or to see if you’re on track preparing for retirement, you can reach my office at 303-744-1128. If you’re driving… Reach out and contact KLZ, and they will put you in touch with me. Earlier, the beginning of the year, the 10th of January, we had an event called Essential Tax Strategies for Retirement. We had that at Arapahoe Community College. It was very successful. We had only a few remaining seats. There were about 35 people in a classroom. We’re having another one of those at the Belmar Library Thursday, March 19th. It will be from 6 p.m. until 7.30. And if you would like to attend that event, contact my office at 303-744-1128. Again, it will be… An educational event. We’ll be talking about essential tax strategies for retirement. And many of those people who attended that event have chosen to work with us and did appreciate the information that we provided. Now, from listening to me, you may know that I enjoy reading. I’m pretty much an avid reader. I know there’s a lot of people who read more than I do, but I find certain books incredibly interesting. One of my favorite authors is a man named Atul Gawande. He’s a second generation man from India. He is also a cardiac surgeon, and although he’s trained in the field of medicine, he found himself looking for a place for his aging father when his father’s health began to deteriorate, for lack of a better word. And once he began this quest, he sort of realized that Western civilization, the United States in particular, has great medical care. We’ve made tremendous advances and so forth, but there has been almost no emphasis on how to improve the quality of life as people age. And As a result of his quest of finding a place for his father, he began to do a lot more research. And he learned that in our culture, compared to other cultures, many seniors are living independently. And living independently, that sounds good. Financially, they’re independent, but they can also be very much isolated people. Result is loneliness and depression and that sort of thing. So how we care for our elderly is basically what his book is about. The title of the book is Being Mortal. And in that there are conversations about terminal illness. MDs are trained very highly in specific techniques, but they don’t receive a lot of training in how to handle end-of-life circumstances. I know those of you who are heavily involved in nutrition, physicians in their medical school get a couple of weeks of training nutritional education over the course of about three or four years of medical school. So some of these things are topics we need to sort of reach out ourselves to learn about. And again, Atul Gawande learned that there is kind of almost an avoidance of end-of-life conversations with people who are You know, near the end of their life, they may be suffering and so forth. And these are things that that the book covers. End of life conversations. How do those conversations go? What’s the best way we can provide for the elderly when their health begins to deteriorate and so forth? And I think health care providers, they need to facilitate discussions that help families prepare for when a loved one’s health begins to deteriorate and it’s near an end-life circumstance. The book also talks about what they call holistic care, sustaining the quality of life and improving capabilities rather than just medicating or healing or treating health problems. Geriatricians, for example, which is the field of medicine of treating the elderly, there is a shortage of those. But those who are in that field, they have sort of a comprehensive approach, or at least this is what Atul Gawande is pushing and highly recommending, a comprehensive approach that includes medical care, in addition to social connections and emotional well-being. And the reason these are incredibly important is folks who are older and somewhat isolated, not only can they suffer from depression, but the likelihood of dementia becomes greater when the social connections are fewer. So a lot of things… to think about once we read his book. Now, one of the parts that I found incredibly interesting in his book was when he gave a couple of examples of some of the elderly. Atul’s grandfather, his name was Sitaram. He lived in India. He lived to be 110 years old, and he was cared for by family, even though he wanted to continue to run his farm, probably somewhere in his 90s or age 100 and so forth, is about the time that he began receiving his support and so forth by other people in his village. and he contrasted Atul Gawande in the book contrasted that to Alice who is his wife’s grandmother. She lived for 30 years after her husband died at age 56 of a heart attack and because she had adequate resources she was able to live alone for 30 years but by age 84 her health began to suffer significantly along with her memory. And what they have found through a lot of research and so forth is people who live alone and independently, if they don’t have a lot of social contact and so forth, the likelihood of their health decreasing. deteriorating as well as their mental health deteriorating that is much much more likely to take place. Now one of the positive things he talks about in the book is the development or the rise so to speak of assisted living. There’s a woman whose name is Karen Brown Wilson She is one of the founders of assisted living. Prior to having assisted living facilities, they haven’t been around forever, people who, when they reached a certain age, they were either cared for in their home Or they were placed in, they didn’t even use the word nursing homes back then. They called them old folks homes or rest homes or things of that nature. But those were the choices. There was nothing in between. And the big advantage of assisted living facilities is they can be nearly independent where someone may have an apartment with other people in a larger building and prepare all their own meals and so forth. And assisted living facility may also have other services that are offered sort of on an a la carte or cafeteria basis, depending on the needs. Some people who live in assisted living may need assistance with their medications. Some of them may need some ambulatory assistance, things of that nature. Some of them may want to take advantage of meal preparation. So there’s an enormous… and that also reflects the cost. The cost of assisted living can be somewhat moderate. By that, I’m talking $4,000 or $5,000 a month, or it can be considerably higher if a lot of these other services are provided. And some of those may be medical in nature. Some of them may be more convenience-oriented and so forth. Another thing in the book I felt was really interesting is he described the story of a young man who came right out of medical school, and his job was to be director of a nursing home. And the nursing home where he went to work. to direct and be the boss of, so to speak, it was highly regimented. The people all ate at the exact same time. They would go into certain parts of the building at the same time. They might be able to go somewhere in the bus at exactly the same time. And it was highly regimented. And a lot of the people kind of walked through the hallways almost looking like zombies because there wasn’t much change, there wasn’t much joy. Not that nursing homes are a place that’s necessarily full of joy, but when he began his job as being the head of this nursing home, he introduced things like houseplants, like people actually having birds. or other pets, they began to do a little traveling beyond just going to church or going to the local mall. And a statistic that I can’t quote where I heard it, but I have heard that 70% of People who live in nursing homes receive no visitors, in spite of the fact many of them have family members who live nearby. For a period of time, about a year and a half, I drove an elderly gentleman who was a retired police officer, also retired from the Navy. to church every week. And he enjoyed going to church. He was a Christian, but I got a feel for what the nursing homes were actually like. And I know, although his sister lived in the community, he would only see her just a very few times each year. And essentially, I would be there on Sundays to take him to church. And although there were probably 100 people in this facility, I would only see what I could count on one hand of the people who were coming there to visit some of the folks in the nursing home. So the book gives us a real clear picture of how we care for or don’t care for you know, the elderly. And I think getting a good understanding of that is important. And in my field as a retirement planner, financial advisor, we need to think in terms of how would this fit into our retirement plan or my retirement plan? Where would the money come from? And what kind of services might I be needing? So these are things to think about. And after the break, I’m going to talk about Atul Gawande’s other book, which I have read. I also found very interesting. It’s called The Checklist Manifesto.
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I’ll see you next time. This information will help Al design a unique plan using resources that will build and protect your retirement and remain within your comfort level. Al is highly skilled at creating conservative strategies that help minimize losses. If the market turns your retirement stays on track. Al learns what matters to you and then builds a custom solution that makes sense for you, including covering the what-ifs of life. Be confident and prepared for retirement. Contact Al Smith of Golden Eagle Financial today and get started on your personal path to retirement by finding him on the klzradio.com advertisers page. Investment advisory services offered through Brookstone Capital Investment, LLC, a registered investment advisor. BCM and Golden Eagle Financial Limited are independent of each other. Insurance products and services are not offered through BCM, but are offered and sold through individually licensed and appointed agents.
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Welcome back to Retirement Unpacked. I’m giving two book reviews today. The first one I already did. The title of the book is… The author of the first is Atul Gawande, and the title of that book is… Being Mortal, and that is about how we treat or how we care for or don’t care for the elderly. It’s an extremely good book. I know you would find it enjoyable. Anyone who is in the healthcare field or has… parents who are aging or anything like that I would highly recommend the book because it paints a really clear picture of some areas where we’ve improved in health care for the elderly but also some areas where there’s some really big gaps. Now Atul Gawande although he is a cardiac surgeon he also is a a very bright man and a tremendous author and that’s the reason when i heard about his second book i purchased it and i’ve read it i think twice and the title of the second book is the checklist manifesto and one of the things i thought i would do before i dove into the book is Describe what is a manifesto? Well, it comes from the word manifest, but a manifesto is like a statement that makes the intention of the author of that statement very, very clear. And what we often hear when there is some kind of terrorist who is wanting something and he wants society to change, like the Unabomber, he had a manifesto because he was, you know, some kind of an intellect besides being incredibly evil. But any event, the checklist manifesto talks about the importance of checklists in the extreme complexity of the world in which we live. And the primary areas that he talks about are medicine, construction, and aviation. And as far as the unbelievable complexity, I’m going to go through a short excerpt of the book where he talks about a small Austrian town in the Alps These parents went on a walk with their three-year-old child and the parents lost sight of the girl for a moment. And when they finally found her, she fell into an icy fish pond. The parents jumped in after her, but she was lost beneath the surface for 30 minutes until they find her alive. Finally found her at the bottom of the pound. They pulled her out of the surface to the shore. They called an emergency response team. They arrived within about eight minutes, and the rescue personnel, she was unresponsive. and there was no blood pressure, no pulse or sign of breathing. Her body temperature was 66 degrees. Her pupils were dilated, unreactive to life. The emergency technicians did CPR anyway. A helicopter took her to the nearest hospital where she was wheeled to an operating room. A surgical team got her into a heart-lung bypass machine. The surgeon had to cut through the skin of the child’s right groin to sew in a desk-sized machine, silicone rubber tubes into her femoral vein. There were tremendous services that she received, and this is in a rural area in the Austrian Alps. And between the transport time and the time that it took to plug in the machine into her, she had been lifeless for an hour and a half. By the two-hour mark, however, her body temperature had risen almost 10 degrees and her heart began to beat. It was her first organ to come back. After about six hours, her core temperature reached 98.6. The team tried to shift her from the bypass machine to a mechanical ventilator, but the pond water and debris had damaged her lungs. The surgeons had to open her chest down to the middle with literally a power saw and to make a medical story briefer than what it is in the actual book. They worked on her for hours and hours and over the next two days, all of her organs recovered, her liver, kidney, intestines, everything except her brain. The CT scan showed global brain swelling, so they actually drilled a hole in her skull And they threaded a probe into the brain to monitor the pressure. And after more than a week, she laid comatose. And after about that time, she came back to life. Her pupils started to react to light. Then she began to breathe on her own. This all occurred when this young child was three years old. By the time she was five years old, she had fully recovered. She was like any other five-year-old. The things that can be done by the medical community are unbelievably miraculous, but this could not have been done without the expertise in spite of extreme complexity. Because when someone is in a circumstance like this, we see on TV where someone’s in the water, they come out of the water and they do quick CPR and they throw up a little water and then they’re right back to life. Well, this was a circumstance very, very different. She was, you know, not breathing for a very long time, and she suffered some conditions that lasted a few years by age five. This happened when she was age three. She was fainting. fully fully recovered. But the bottom line is checklists are incredibly important in making complex circumstances doable. My office has a large conference room, and it’s shared by myself. If I choose to use it, there is also a roofing company and a construction company. And I can’t help but notice after they have a large meeting in this office, there is an enormous whiteboard, and it has a very, very big checklist. And it has anything from getting permits to… A little thing saying, leave it just like you found it. In other words, if you’re working in someone’s home, completely clean up as if you were never there. But the checklist for these construction companies, one’s a roofing company and one’s like a general contractor, these go into great detail. And in the book, Atul Gawande, he talks about the general construction manager where high rises are built. And I can’t imagine anything more complex in the construction industry other than building high rises. I occasionally watch the Smithsonian Channel, and they talk about some construction projects of buildings unbelievable buildings that are like art museums and things of that nature that have enormous construction difficulties that they manage to handle. But in construction, checklists are incredibly important because in construction, if you’ve ever done a project or done an addition on your home, things have to be done in a certain order. You can’t do the electric until you do the framing, and things have to follow a certain order, and there need to be permits gathered at various elements of the completion of the project. So I thought the construction component of that was incredibly interesting. The aviation component was also really interesting and I’ll read just a little bit of a chunk about the aviation component. That had to do with in 1935 at Wright Airfield in Dayton, Ohio, the U.S. Army Air Corps had a competition for an airplane manufacturer to build the next generation of long-range bombers. And the Model 299 of Boeing trounced Martin and Kennedy. Martin Douglas’ offering of another one. And this bomber was supposed to carry five times the payload of the previous bomber. On its initial flight, they were expecting great, great things, but it crashed because the B-17, which it was later named, was so complicated it was difficult to fly. Hence, the birth of the aviation checklist. If you want to learn more about that, watch the Smithsonian Channel on TV. As a person getting close to retirement, we have a retirement checklist, which I would highly encourage you to learn about. You can learn about it At my office, 303-744-1128. I want to thank you for tuning in. Again, Atul Gawande is the author. Checklist Manifesto is his most recent book. Being Mortal is the previous book. They’re both really good reads. Thank you for tuning in. God bless you. And let’s pray for the safe return of Savannah Guthrie’s mother. Bye now.
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